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VJHemOnc Podcast
iwAL 2023 Session IV: Transplantation and immunotherapies in AML: improving patient outcomes
Oct 20, 2023
Charles Craddock and David Sallman discuss transplantation and immunotherapies in AML, focusing on patient eligibility, challenges in CAR-T therapy, targeting pre-transplant minimal residual disease, and improving patient outcomes through DLI and gamma delta T cells. They also explore the design of a randomized study evaluating prophylactic DLI in high-risk AML patients.
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Quick takeaways
- CAR T-cell therapy in AML shows promise, but response rates and durability of responses need improvement, and innovative approaches like compound cars and personalized patient selection are being explored.
- Measurable residual disease (MRD) is a prognostic indicator in AML, and targeting MRD-positive patients with novel therapies before transplant, especially less intensively treated and older patients, could improve outcomes and advance AML treatment.
Deep dives
Advancements in CAR T-cell development in AML
CAR T-cell therapy has shown promise in AML, with CD33, CD123, and CLL1 being the main targets in clinical trials. However, response rates have been low, and the durability of responses is a challenge. Optimism remains high, and researchers are exploring out-of-the-box approaches, such as compound cars with multiple antigens, to improve efficacy. The role of CAR T-cell therapy in patients with TP53 mutations is still uncertain, given the unique biology and immune microenvironment of these patients. While challenges remain, there is hope that CAR T-cell therapy can be optimized through early trials, personalized patient selection, and combination treatments.
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